Methods to Help You Quit

Start Living a Tobacco Free Life

Getting StartedMany people have quit smoking. You can too! The thought of quitting tobacco use can be overwhelming. It can be hard to deal with the cravings and withdrawal symptoms, but the long term health benefits that you will gain through quitting make the journey worthwhile.

The Lung Association of Nova Scotia would like to help you quit and help you stay tobacco free in the future. There are many methods, options and supporting materials out there that can help you achieve success. Deciding to quit is the first step. This booklet will outline some different methods for your consideration to help you achieve your goal of living a tobacco free life.

Through this booklet, you will learn about the different methods and support services available to help you on your journey to quit. The information provided refers to quitting cigarette smoking as this is the most common form of tobacco use. However, the recommendations are also transferable to those wanting to quit their use of smokeless tobacco products. Only medications approved by Health Canada are discussed in this booklet.

All of these proposed methods are considered most successful when combined with counseling and we recommend that you work with your health care provider to design a quit plan best suited for your lifestyle.

For more information on quitting strategies, ways to cope with withdrawal symptoms, and relapse provention, please visit www.lung.ca/quit

Get PreparedWhat to Expect

Quitting is tough. Cigarettes contain the highly addictive drug nicotine. Through smoking, your body and your brain have gotten used to nicotine and suddenly cutting off this supply can cause withdrawal symptons. Withdrawal symptoms will vary from person-to-person. Some people will find their symptoms easy to manage while others will find them unbearable. It is important to remember that these symptoms will not last forever. In most cases, withdrawal symptoms begin to decline after the first week.

While each individual will face their own unique set of of withdrawal symptoms, common ones include:

•Irritability•Low Energy•Sleepiness•Cold Like Symptoms•Dizziness

•Lack of Focus•Hunger•Cravings•Chest Tightness•Gas

How to Cope

Finding effective ways to cope with cravings can be very useful in managing your withdrawal symptoms. When you find yourself with the urge to smoke, try one of the following tactics instead:

Drink Water or Chew GumWater will help to flush the nicotine and other chemicals out of your system faster. Also, taking a drinkor chewing on a piece of gum can help keep your mouth busy and help you fight off the craving.

Try to RelaxTake a deep breath break instead of a smoke break. Breath in, pause for a few seconds, and slowly exhale. Yoga and meditation can help you relax and keep your mind focused.

Delay As Long As PossibleTry to wait the craving out, and eventually it will pass. Don’t try and convince yourself you ‘can just have one’ as this often leads to using tobacco again.

Switch Up Your RoutineWhen trying to quit, you can find ways to avoid triggers by switching up your routine. Appoint a ‘Quit Buddy’ who you can talk to until the craving passes, integrate physical activity or take up a hobby that will keep you busy and distracted until the craving passes.

Methods to Help You QuitThe ‘Cold Turkey’ Method

Quitting ‘cold turkey’ means that the smoker has stopped smoking immediately, without the use of any medications. The majority of people who quit thier tobacco addiction use this method. Quiting ‘cold turkey’ is free, does not require a prescription, and your body will begin to heal itself immediately.

Because you quit suddenly, the amount of nicotine in your blood stream declines quickly. As a result, your body may experience some symptoms of withdrawal. How strong these symptoms are, and how long they will last, vary but for most people they generally subside in a week or two.

Nicotine Replacement Therapy (NRT)

NRTs available in Canada include nicotine gum, patches, lozenges and inhalers. All forms can be purchased without a prescription at a pharmacy. They act to replace the nicotine that would be obtained from smoking.

Nicotine is the addictive component in tobacco. Nicotine from NRTs will enter your bloodstream after being absorbed through the layers of the mouth or skin. This differs from smoking where nicotine enters your body through the lungs. In order to minimize or avoid withdrawal symptoms, NRTs allow your body to still receive nicotine, but without the harmful additives that come with tobacco use.

Studies indicate a better success rate of quitting by people using NRTs. The amount of nicotine in an NRT may be less than the amount normally derived from smoking. Recommended dosages can be adjusted and NRTs can be used in conjunction with each other. This may be important to those with a greater nicotine dependence or for people who have experienced withdrawal effects during a previous quit attempt. Your health care provider can assist you to individualize your treatment plan.

The recommendations for NRTs often vary depending on the different brands and products. The recommendations outlined in this this document are to be used as a general guideline. To ensure your safety and best results, follow the manufacturer recommendation for your specific NRT and the treatment plan outlined by your health care provider.

Nicotine Replacement Therapy

Nicotine Replacement TherapyNRT: Nicotine Gum

Where can I get it?You can purchase nicotine gum at a pharmacy. No prescription is required.

How is it used?By mouth as a chewing gum and should not be swallowed. You can control the time and amount of nicotine delivered. Dosages come in 2mg and 4mg pieces, as needed.

Method of Use:Chew the gum slowly until you can taste the nicotine or feel a slight tingling in your mouth. Then stop chewing and ‘park or place’ the gum between your cheek and gum. When the tingling is gone, approximately one minute, start chewing again and repeat the process for approximately 30 minutes. Avoid drinking acidic beverages such as coffee or soft drinks for 15 minutes before or during chewing as it may prevent the gum from working properly. Do not chew more than 20 pieces per day.

Duration of Use:Duration varies depending on each individual, however nicotine gum is recommended for approximately six months. Use after six months is still safer than using tobacco products, but requires a follow up conversation with your health care provider. Gradually decrease the number of pieces chewed per day by one piece every four to seven days. Also decrease the chewing time from the normal 30 minutes to 10-15 minutes for every four to seven days. Consider discontinuing your use of nicotine gum once your cravings are satisfied by one or two pieces per day.

Most Common Side Effects:Upset stomach, hiccups, sleep disturbance, sore jaw and/or headache.

NRT: Nicotine Patch

Where can I get it?You can purchase nicotine patches at a pharmacy. No prescription is required.

How is it used?The patch is applied directly to your skin. A steady delivery of nicotine is absorbed into the body which you do not control. Dosages come in 7mg, 14mg and 21mg patches.

Method of Use:The patch is applied once a day, usually at the same time each day. Vary the spot of application on a daily basis. The nicotine patch may be used for 16-24 hours/day depending on the manufacturer. Consult with your health care provider to find a dosage that works best for you. Apply the patch to a clean, dry, hairless piece of skin. Avoid areas of irritated, scarred or broken skin. Dispose by folding in half with sticky sides touching.

Although not recommended by manufacturers, recent studies suggest that your chance of success increase if you start using the patch a week or so before you stop smoking. Therefore, some health care providers may recommend an earlier start.

Duration of Use:Duration varies depending on each individual, however the nicotine patch is recommended for approximately three months. Use beyond three months is still safer than using tobacco products but requires follow up with your health care provider. Gradually switch to a lower dose but continue to use daily. Discontinue when you have confidence to stop nicotine usage.

Most Common Side Effects:Irritation at patch site, sleep disturbance, abnormal dreams, headache, nausea and or dizziness.

All products containing nicotine are dangerous to children and pets. Please store them in a safe place and dispose of them

responsibly.

Nicotine Replacement TherapyNRT:Lozenge

Where can I get it?You can purchase nicotine lozenges at a pharmacy. No prescription is required.

How is it used?By mouth in lozenge form. The user controls the time and amount of nicotine delivered. Dosages come in 1mg and 2mg lozenges, as needed.

Method of Use:Place lozenge in your mouth. Slowly suck the lozenge until a strong taste is noticed, then ‘park or place’ the lozenge between your cheek and gum. When the taste fades, repeat by sucking the lozenge again until the strong taste is noticed. Typically, one lozenge should last about 30 minutes before being completely consumed. Do not use more than one lozenge at a time. Avoid drinking acidic beverages such as coffee or soft drinks for 15 minutes before or during chewing as it may prevent the lozenge from working properly.

Duration of Use:Duration varies depending on each individual, however, nicotine lozenges are recommended for approximately six months. Use after six months is still safer than using tobacco products, but requires a follow up conversation with your health care provider. Gradually decrease the number of lozenges used per day. Consider discontinuing your use of nicotine lozenges once your cravings are satisfied by one or two per day.

Most Common Side Effects:Sleep disturbance, sore throat or mouth, hiccups, heartburn, indegestion and/or upset stomach.

NRT: Nicotine Inhaler

Where can I get it?You can purchase nicotine inhalers at a pharmacy. No prescription is required.

How is it used?The inhaler is made up of a mouth piece and a replaceable nicotine cartridge. When you inhale on the mouth piece, the cartrige releases nicotine into your body and reduces your cravings. It is held like a cigarette, allowing you to keep your hands busy. You control the time and amount delivered. Dos-ages come in 4mg cartriges as needed.

Method of Use:Inhale from a cartridge when you have a desire for a cigarette. One cartridge will last about 20 minutes if you inhale frequently. Typically you will inhale be-tween six to 12 cartridges a day. Do not use more than 16 cartridges a day.

Duration of Use:Duration varies depending on each individual, however the nicotine inhaler is recommended for approxinmately three months. Use beyond three months is still safer than using tobacco products but requires follow up with your health care pro-vider. Gradually decrease use over a two to three month period. Discontinue when you have confi-dence to stop nicotine usage.

Most Common Side Effects:Local irritation in mouth and throat, sneezing and/or coughing.

All products containing nicotine are dangerous to children and pets. Please store them in a safe place and dispose of them

responsibly.

Prescription OptionsPrescriptions

Prescription medications can be used to lessen the potential symptoms of withdrawal.

Tobacco dependence might be best thought of as a chronic addiction, requiring repeated episodes of treatment. This suggests that you may find it helpful to use some form of medication to stop using tobacco.

We suggest consulting with your health care provider as there can be circumstances when medical prescriptions are not recommended (e.g. incompatibility with other medications). All medications may exhibit side effects and it is useful to be able to disucss this with a health care professional.

If you normally smoke within the first half hour of waking, or you smoke more than 15 cigarettes a day, then medications are likely to be of even greater assistance to you. Should you decide to use medications, check to see if your health care insurance plan offers any financial support. Remember, that in the long run, the financial benfits of quitting out-weigh the initial costs of medications.

Champix and Zyban are the only two perscription medications for quitting smoking currently available in Canada. Champix and Zyban are both taken in pill form but act very differently in the body. Because these medications are prescribed, a consultation with your health care provider is necessary. It is important to review any health conditions that you have and discuss all medications you are currently taking before using these prescriptions.

When considering a prescription, it is important to consult with your health care provider to fully understand your

compatibility and the potential side effects.

Champix vs ZybanChampix (varenicline)

Where can I get it?See your health care provider, they can provide you with a prescription.

How is it used?It is taken in pill form. Dosages are availabe in 0.5mg and 1mg options.

Method of Use:Start taking Champix pills twice a day a week be-fore quitting smoking. On the day you quit smoking you switch to a higher dose of medication, one pill in the morning and one pill in the evening.

Champix works by stimulating dopamine, in a similiar fashion to nicotine. Dopamine is an important messenger in the brain. This results in reduced cravings and withdrawal symptoms. This drug also prevents dopamine release that occurs with nicotine consumption. This means the pleasure you get from smoking is decreased. Champix is not recommended for use in combination with NRTs because it competes with nicotine for receptor sites in the brain.

Duration of Use:An intial Champix prescription lasts for 12 weeks. Repeating a course of treatment is possible, An extended, lower dose is not normally done but can be used if you experience an increase in irritability, an urge to smoke or sleep disturbance.

Discontinue when you have confidence to stop nicotine usage.

Most Common Side Effects:Nausea, sleep disturbance, constipation and/or upset stomach. The possiblity of having sucidal thoughts has been attributed to this drug. Call your health care provider immediately if you experience any signs of depressed mood or behaviour change that is not typical for you.

Zyban (bupropion)

Where can I get it?See your health care provider, they can provide you with a precription.

How is it used?It is taken in pill form. Dosages are availabe in 150mg and 300mg options.

Method of Use:Treatment should begin while your are still smoking, since approximately one week of t reatment is required to achieve steady-state blood levels of Zyban. You should set a target quit date and quit smoking sometime during the second week of treatment. Zyban may be used in combina-tion with NRTs.

Usually the 150mg/day dosage is used for the first three days followed by a dose increase to the recommended 300mg/day. There should be an interval of at least eight hours between successive doses.

Duration of Use:Zyban is normally taken for seven to 12 weeks, Longer treatment is possible if you and your health care provider feel it is beneficial.

Most Common Side Effects: Dry mouth and/or insomnia.

All prescription medications are dangerous to children and pets. Please store them in a safe place and dispose of them responsibly.

To learn more or to donate, please call:(888) 566-LUNG (5864) or visit www.ns.lung.ca

Also find us on:

The Lung Association of Nova Scotia

@NSLung

Provincial Office - 200-6331 Lady Hammond Road, Halifax

Additional ResourcesTobacco Free Nova ScotiaTobacco Free Nova Scotia is a personalized and non-judgemental support to help you quit and stay quit. All services are free and confidential and in-clude a quit line, text-based and online chat with counselors. Call 8-1-1 or register online.

Doctor or PharmacistYour doctor or pharmacist is an excellent resource. You may want to consider trying nicotine replace-ment therapy (gum, patch, inhaler) or a prescription to help you quit and stay quit.

Addictions ServicesAddiction Services offices are located throughout Nova Scotia to help individuals, families and com-munities with problems created by the harmful use of alcohol, other drugs and gambling. They help sisters, brothers, moms, dads, husbands, wives, co-workers and friends achieve a safe and healthy lifestyle.

The Canadian Cancer SocietyThe Canadian Cancer Society offers two booklets for smokers. One booklet is for smokers who are not quite ready to quit and the other is for smokers ready to try and quit. The Canadian Cancer Society Halifax office can be reached at 902.423.6183 or toll free at 1.800.639.0222 or by email at ccs.ns@ns.cancer.ca

Freedom From SmokingFreedom from smoking is an online quit program developed by the American Lung Association. It takes you through modules, each containing several lessons you are trying to complete, as you move through the program. This resource can be accessed anytime, day or night, on a schedule of your choosing.www.ffsonline.org

Quit4LifeTeen smokers can use this online quit program available from Health Canada. www.quit4life.ca

Additional Resources There are a number of quit smoking apps for iPhone and Android devices that can help you track your progress through your mobile device.

Examples include:• Smoke Free• Kwit• LIVESTRONG My Quit Coach• Craving to Quit• Quit Pro

Explore the various programs to see if there is one that resonates with you and your goals.